All posts by The Attached Family

A mother on a mission can do amazing things, especially when working with an equally passionate parent support advocate.

Nancy Mohrbacher, a La Leche League (LLL) leader in Chicago, Illinois, USA, said it was a mother in her group who gave birth to an idea that has become the Mothers’ Milk Bank of the Western Great Lakes—one of a number of milk banks sprouting up around the world to serve mothers who are unable to breastfeed exclusively but no longer want to settle for formula.

“We need more milk banks to save more lives,” said Mohrbacher, IBCLC, FILCA, author of Breastfeeding Answers Made Simple, and chair of the board of directors for the now-developing Mothers’ Milk Bank. “And this seems to be an idea whose time has come because many are springing up all over.”

The mother in Mohrbacher’s LLL group gave birth to a preterm boy, and the hospital staff insisted that he receive formula because he was too weak to exclusively nurse. The mother knew about the lifesaving and life-giving properties of breast milk, and she knew about the potential negative outcomes of feeding formula to a preterm baby. She told Mohrbacher that she would have preferred to feed her baby donor breast milk.

This mother went on to ask Mohrbacher to help her start a milk bank for the Chicago and Wisconsin areas—a region with one of the highest infant mortality rates in the United States and for which a formal recommendation was made by the Wisconsin Neonatal Perinatal Quality Collaboration that low-birth-weight babies be fed pasteurized donor breast milk, rather than formula, when the mother’s own milk is not available.

For those families who have healthy babies, but for some reason the mother was unable to breastfeed, milk banks can meet their needs as well, provided that critically ill and preterm infants have been helped first.

The preterm baby in Mohrbacher’s group had a milder condition than other babies who are admitted to hospital neonatal intensive care units for care, and he is now nursing well despite formula supplementation. But for very preterm or more severely ill babies, anything other than human milk can cause serious health problems, like necrotizing enterocolitis (NEC), which occurs when a part of a baby’s intestines becomes inflamed and dies. The treatments for NEC account for 19% of all newborn health care costs. When NEC requires surgery, half of the babies treated die, and many of those who survive suffer from lifelong disabilities. Breast milk helps prevent NEC.

According to a 2009 study (Quigley, M. et al. “Formula milk versus donor breast milk for feeding preterm or low birth weight infants”), small preterm babies fed infant formula are two-and-a-half times more likely to develop NEC than those fed pasteurized donor human milk. The components unique to human milk prevent the inflammation that causes NEC, among other complications. Even partial human milk feedings are much less likely to cause a baby to become seriously ill.

“Human milk is preventative medicine for these babies,” Mohrbacher said.

With the advances in medical technology, more preterm infants are able to survive outside the womb. Since premature delivery and medical complications can reduce a mother’s milk supply despite her best efforts, more donor human milk is needed. Despite the life-saving properties of breast milk, the price per ounce for donor milk ranges from $3.50 to $4.50, and a prescription is required. Part of the expense stems from the pasteurization process, which is essential for preterm babies, as any pathogens in the milk could make an already sick or unstable infant more ill.

“Because the cost of collecting, processing and distributing pasteurized donor human milk is so high, even selling milk at cost puts it out of reach financially for most families,” Mohrbacher said. “A healthy 1-month-old usually takes between 25 and 30 ounces per day. Preterm babies need far less milk, [but] the health risks of infant formula are much greater for them.”

In general, the cost of feeding a premature baby donor breast milk in the hospital is shifted to the hospital itself, government programs and insurance companies. After a critically ill baby leaves the hospital and a family can no longer afford pasteurized human milk, the charitable arm of a nonprofit milk bank will often reach out to supply these families with the milk that will protect their babies.

Mohrbacher and her coworkers have assembled a team of experts to find a facility, buy equipment and begin processing donor milk for their region. They estimate that they will need approximately $1 million to open their processing facility and establish the charitable arm of the milk bank. Within three years of opening, they predict, the $4.50 per ounce that hospitals pay for human milk will allow their bank to become financially self-sustaining.

As Mohrbacher and the Mothers’ Milk Bank prove, you do not have to be famous or rich or powerful to make a difference. Any caring individual, with proper help and funding, can establish a nonprofit milk bank. The Mothers’ Milk Bank are first and foremost a group of people who care about saving infants’ lives and are determined to help those infants survive and thrive.

You can read more in the double “Voices of Breastfeeding” issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members–and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.

When a woman makes the choice to breastfeed, she usually doesn’t anticipate that it won’t work. After all, we are told that almost everyone can breastfeed—and this is true: Lactation is a robust biological process that almost always works.

But though there are only a few medical conditions in which breastfeeding may be limited, there are many medical circumstances that can present lactation and feeding challenges. Mothers who wean early for medical reasons or who are never able to breastfeed at all suffer a loss and may experience a spectrum of emotions that range from disappointment, frustration and anger to guilt, sadness and grief to relief and acceptance.

Editor’s Note: The description of certain medical conditions and breastfeeding recommendations contained in this article are specific to individual cases. It is not advice. Contact your health care provider for medical advice on these or other conditions. Contact an International Board-Certified Lactation Consultant (IBCLC), La Leche League (LLL) Leader or another breastfeeding specialist for more information regarding breastfeeding concerns in your individual case.

A Heartrending Choice

Kim Barbaro of Warminster, Pennsylvania, USA, faced the difficult choice of weaning when she developed a breast abscess that required surgery. Her surgeon explained that the incision would be long and deep, extending into the areola, and would remain open for some time, requiring packing twice a day.

Kim says that while her doctor gave her facts about the surgery, she was also understanding and empathetic: “She absolutely left the decision up to me,” she said. “But she didn’t just talk about the medicine; she talked about the bonding and the quality of time and being a working mom, and that really pulled me to her. It was that level of compassion and understanding that made a gigantic difference.”

“At first I was just confused, definitely torn between two worlds,” Kim added. “I think one of the biggest things for me was that bonding piece [with the baby], because it is so strong, and I didn’t want to be without it. I finally felt like my body was doing what it was supposed to do.”

In the end, Kim decided to wean: “After I started really thinking about it and took the emotional piece out, I knew there was just no way,” she said.

During her recovery, her emotions swung from grief to guilt to resignation, Kim says: “I went through a period of just sadness at that time I was feeding with a bottle. Logically I knew I made the right decision—it was not going to be possible—but emotionally it was another world. I would bounce back and forth, and just when I would get emotional, I would try and tell myself I wasn’t being realistic. You have to convince yourself and get support for that.”

When a mother must wean immediately for medical reasons, support is essential. Mairéad Murphy, IBCLC and La Leche League Leader in Dunboyne, Co. Meath, Ireland, explained: “It’s important that such moms get help on a practical level, because they may need to do some expressing to avoid engorgement and mastitis. But they also need support just to come to terms with the whole thing. It is very much a process of loss and grieving, because this portrait they had of being a mother has changed drastically.”

Kim had planned on a natural labor and birth with midwives, but she ended up with a last-minute Cesarean section. Neither Kim’s birthing experience nor her breastfeeding experience turned out as she wanted.

“I had expectations about how my birth was going to go, and it didn’t go that way,” she said. “And if you go to breastfeeding class, and they tell you all of the benefits and how it is so superior to formula, then you do feel guilty [if you can’t breastfeed]. It’s that mother nurture instinct—you just want to provide.”

When Weaning is the Only Option

It was about the time of her daughter’s first birthday when Wendy Friedlander received the devastating diagnosis that she herself had a rare form of cancer that would require her not only to wean her daughter but to live apart from her for a year while she underwent chemotherapy treatment.

“That was the hardest conversation I ever had in my life,” said Wendy, who lives in New York City, USA. “I wept three boxes of tissues. The doctor literally told me I had to give up a year of my life to save the rest. I had a week before treatment started, before I knew I would have to wean. And it wasn’t just stopping the nursing, it was everything—the babywearing, the breastfeeding, the cosleeping.”

Daytime weaning was easier than expected, as her daughter filled up on hugs and smiles instead of nursing for comfort throughout the day. However, night weaning was more traumatic. In her blog post “Weaning Early,” Wendy wrote: “The night weaning was like ripping off a Band-Aid. Where I was the Band-Aid, and just like that, I was taken away, and it was up to my daughter and her father to get through those first milk-less nights.”

With her large supply of milk, it was imperative for Wendy to continue pumping regularly because a blocked duct could turn into a life-threatening infection. It was a difficult balancing act, removing enough milk to prevent problems while at the same time trying to decrease milk production, all while she was extremely ill from treatments and living apart from her family.

“Everything else seemed so big, weaning was just an aside,” Wendy wrote. “And yet, the pain and heartbreak were tremendous.”

Education and Support are Critical

Apart from genuine contraindications to breastfeeding, there are many medical conditions and circumstances that may affect breastfeeding. With the right diagnosis, information, intervention and support, some breastfeeding may be possible if desired by the mother. Sometimes temporary weaning is needed, or a mother may need to supplement with expressed milk or formula.

Medical professionals may act as barriers to breastfeeding at times: “There are some conditions where breastfeeding is contraindicated, and it’s quite right,” Murphy said. “And there is another group of conditions where mom is told not to breastfeed, and it’s not the truth.”

This is not a condemnation of physicians, most of whom are caring individuals who have the best interests of their patients at heart. However, crushing patient loads, the critical need for good outcomes and simple lack of the most up-to-date information on lactation may lead them to make recommendations that unnecessarily compromise breastfeeding. This underscores a mother’s need for self-education and support.

Mihaela [last name withheld by request] had hepatitis B as a child but had no further problems with the condition for the rest of her teen and adult years. When she was 26 weeks pregnant, a blood test showed what her doctor called “pregnancy hepatitis.” Upon receiving this frightening news, she began having contractions. She spent the next seven weeks in the hospital on bed rest, taking medications for the hepatitis and to prevent further contractions.

“Later on, I learned that even if I had had hepatitis, the chances that the baby would have caught it were minimal,” Mihaela said. She also learned she might not have needed to take the medications she was on.

“I didn’t think to read about it myself. It’s a doctor’s responsibility, and if he doesn’t tell you and can’t self-educate, then you can’t protect yourself,” she added.

Her daughter was born at 34 weeks and was placed in an incubator almost immediately, so Mihaela didn’t have the chance to see her for several hours and didn’t hold her until the next day. Her doctor told Mihaela that she shouldn’t breastfeed because of the medications, and she was given pills to stop lactation.

“I was really sad because I imagined that I would be able to do that, but I didn’t have too much time to think about it [the doctor’s recommendation],” said Mihaela, who had assumed she might be able to begin nursing the baby after a day or two.

She and her daughter spent two weeks in the hospital, in separate rooms, until the baby was gaining weight steadily enough to go home. Looking back, she still feels regret and sadness.

“I feel it would have been much, much easier with breastfeeding,” Mihaela said. “I had moments when I was holding her, and she was close to me…breastfeeding would have complemented that.”

It was especially tough when her daughter would nuzzle her breasts, searching for a way to nurse, Mihaela said: “I would have to take her away from the proximity of the breast. It was really hard.”

Common Complications

If a mother requires medication, she may be told she shouldn’t breastfeed, advice based on resources doctors commonly use, such as the Physician’s Desk Reference or information from the drug manufacturers. According to La Leche League International (LLLI), these resources do not contain complete information about effects on breastfeeding, and very few medications are truly incompatible with breastfeeding. A more useful reference is Dr. Thomas Hale’s Medications and Mother’s Milk or LactMed, the U.S. National Institutes of Health’s Drugs and Lactation Database.

Before Wendy’s biopsy, she asked her anesthesiologist for a list of medications needed for the procedure, “and he didn’t want to give them to me, because he knew I wanted to know for myself when I could nurse my daughter again,” she said. The anesthesiologist told Wendy he would not do the procedure unless she agreed to wait 24 hours to nurse. In the end, Wendy did obtain the list of medicines and learned that she only had to wait eight hours to breastfeed.

There are a number of common conditions that generally should not hinder breastfeeding but often do.

Mastitis is an inflammation in the breast requiring frequent and thorough removal of milk, along with plenty of rest for the mother. “Empty breast, lots of rest,” recommends LLLI. Weaning is not required and may actually worsen the condition. If an antibiotic is needed, there are choices compatible with breastfeeding.

“But it’s still very common that a mother will go to her doctor with symptoms which may or may not be mastitis, and she is often told she needs antibiotics and she must wean in order to take them,” Murphy said. “Sometimes I find moms are told to wean for the duration of antibiotics, but this may be seven to 10 days, and for a very young baby, that may create difficulty getting back to the breast. Or a mother may have trouble keeping her milk supply up. Whereas if she was given the direction of getting into bed, feeding a lot, taking painkillers and so on, it may resolve quickly by itself.”

Many of the common causes of mastitis can be resolved with the help of a lactation consultant, and this is especially important if mastitis occurs more than once.

Jaundice, an excess of bilirubin in the infant’s blood, may cause him to be sleepy and less interested in eating. However, because bilirubin is excreted in stool, it’s critical for babies to continue feeding often to resolve the condition. Mothers may be encouraged to supplement with formula while continuing to breastfeed, which can interfere with milk production and baby’s interest in feeding. Rather than go down the route of giving formula, Murphy says mothers can be shown how to rouse a sleepy newborn, how to get him to take extra feeds and how to supplement if needed.

Once a mother begins supplementing with formula, she might not want to stop, because knowing the exact amount the baby is eating helps moms feel more confident, especially in the face of medical problems. It can be hard for a mother to regain trust in her ability to know that her baby is getting enough milk from breastfeeding.

“Sometimes I think with breastfeeding issues, if you could bottle confidence and give it to mom to drink, then everything would be sorted,” Murphy said. “We are so distanced from the knowledge of normal baby behavior. That lack of recognition causes a lot of problems.”

Deciding to Wean

Sometimes a mother may feel that weaning is the best option for her and her family.

“It all comes down to giving the mom information and letting her make a choice with her specific caregiver,“ Murphy said. “Lots of moms have a different path they are prepared to take with breastfeeding.”

When a mom decides to wean, a good lactation consultant or breastfeeding counselor will respect that and reassure her of the good she has done by breastfeeding up until that point.

“And it truly is good, no matter if she has breastfed for two days,” Murphy said.

Due to the stress and uncertainly caused by breastfeeding difficulties, weaning may bring great relief to an anxious mother. The day I (the author) brought my oldest son home from the hospital was the most stressful day of my life. Breastfeeding was not going well, possibly due to a related medical condition, and I was overwhelmed with worry. After well-intentioned but misguided advice from two counselors didn’t help resolve the issues, and after nine exhausting weeks of nursing, pumping and bottle feeding around the clock, I decided to wean. Though I felt tremendous grief and guilt, I was so relieved be free from the ongoing stress of breastfeeding. It was the right decision at the time—and it also fueled my determination to educate myself and get more support when my second child was born. Mothers who wean may appreciate tips on how to mother the baby in a way as close to breastfeeding as possible.

“Sometimes moms see the end of breastfeeding as the end to all that loveliness, but there are still important ways to enjoy the baby,” Murphy said.

Otherwise known as “bottle nursing,” a term coined by Attachment Parenting International founders Lysa Parker and Barbara Nicholson, authors of Attached at the Heart, mimicking breastfeeding behaviors when bottle-feeding include plenty of eye contact, snuggling at feeding times, skin-to-skin contact and feeding on demand. Mothers may also find bathing together and cosleeping helpful for establishing that initial bond with baby.

Moving On

The process of making peace with weaning is different for every mother, and regret may linger.

“I only listened to one person,” Mihaela said. “I didn’t investigate the problem too much. What I would do is read more, ask more. If I had known more about how the baby would be affected, then probably I would have made other decisions.”

Kim had a strong support network of friends with a variety of breastfeeding experiences, friends who helped her come to terms with her experience.

“You have to say to yourself: This does not make or break your relationship with your child, this is not going to be the one and only bonding thing with your child,” she said.

Now a few years past her successful treatment, Wendy said, “It was a gift in so many ways in the end.”

She says her experience improved her relationships with everyone in her life, and it also left her daughter with a huge network of adults with whom she is very close, though the relatives caring for her daughter during Wendy’s illness didn’t always adhere to the same secure attachment-minded practices that Wendy did.

“In the end, it doesn’t matter because they loved her,” she said. “When it comes to a situation where you are low on reserves and low on support, there is only so much one person can do. Your children are getting served by love. That is the number-one thing that serves them.”

You can read more in the double “Voices of Breastfeeding” issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members–and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.

For so many women, breastfeeding was the turning point for our journey into Attachment Parenting. And one organization that many of us have to thank for our introduction to both breastfeeding and Attachment Parenting—even in the case of API’s cofounders Lysa Parker and Barbara Nicholson, coauthors of Attached at the Heart—is La Leche League (LLL) International.

Jeanne Stolzer, PhD, Professor of Child and Adolescent Development at the University of Nebraska in Kearney, USA, whose research is known worldwide as an intelligent challenge to the current Western medical model that seeks to pathologize normal human behaviors including breastfeeding, shares her beginnings in LLL.

“Most people think that because of the research I do, I was raised in a granola-eating, breastfeeding, bare-footed family,” Stolzer said. “Nothing could be farther from the truth. The first breastfeeding baby I ever saw was when I was 18 years old, and I was mortified. Five years later, I saw a woman with a PhD breastfeeding a 3-year-old, and my immediate response was, ‘What is wrong with her?’”

Some years later, Stolzer herself was expecting a baby when a friend encouraged her to attend a LLL meeting: “I was very reluctant, but I went,” she said. As fate would have it, “I instantly felt like I was with kindred spirits.”

“For 99.9% of our time on this earth, we have been hunters or gatherers, and we have been practicing esoteric mammalian parenting,” said Stolzer, meaning non-medicalized births, breastfeeding and staying in close proximity to our babies. “Look at what, in just 100 years, we’ve done: We’re supposed to be the top mammal on the planet, but we’ve managed to completely erase the mammalism in our lives.”

Conception, pregnancy, birth and breastfeeding are intricately linked together as one continuous process to give each baby the best start in life, Stolzer explains: “Most people see these as separate. They’re not. If you mess with one, you risk throwing off the whole connection.”

While there are a very small number of females in every mammal species unable to get pregnant, the United States has the highest infertility rate in the world among humans. But is there any wonder when we stop to look at what Western cultures are doing to the birthing and breastfeeding functions of this process? Stolzer finds it comical that most mothers won’t touch a cigarette or a caffeinated drink while they’re pregnant—which is commendable—but then have no problem in going to a hospital and having powerful narcotics mainlined into their arm during labor and birth. In the United States, 38% of women are getting Cesarean sections when, naturally, only 1 to 3% of births might actually require medical intervention.

Then mothers and their newborn babies are, more often than not, separated immediately after birth. If a mother is able to give birth vaginally, she is flooded with hormones, but by separating the mother from her baby, that hormone flow is interrupted. As if the breastfeeding relationship isn’t challenged enough by separation, then it has to overcome the ordeal of a hormonally-deficient mother and a drug-affected baby: “It takes 138 muscles alone in the jaw to nurse, and if you’re drugged, they won’t work,” Stolzer said.

The truth is, most Western physicians are not educated in breastfeeding. To be so, they must go on to continuing education because medical schools don’t teach lactation.

“I think women do the very, very best they can with the information they have at the time,” Stolzer said. “Breastfeeding decreases all forms of hospitalization, death and prescription drug use. That’s amazing, but how many women who are formula-feeding know this?”

Introduction of Formula Feeding

Formula was developed with the mechanization of the dairy industry and is derived from whey, a byproduct of processing cow milk.

In 1910, only 2 to 13% of mothers formula-fed. After World War I, that statistic jumped to 65 to 70%, and the impression was that only the poor and the immigrants had to “resort” to breastfeeding. Formula feeding had become a status symbol of wealth, and physicians were supporting that formula feeding was superior to breastfeeding. The lesson learned here, says Stolzer, is to question your societal trends: “Formulas are manufactured by pharmaceutical companies. Look at who’s funding every study: If it’s a pharmaceutical company, don’t even read it—it’s propaganda.”

In reality, human milk is far better than any substitute milk. Human milk changes with each child, depending on the needs of that particular child during a particular time of the day, during a particular age of that child. Human milk—and breastfeeding, for that matter—quite simply, can’t be duplicated.

“Pumped milk is infinitely better than formula,” Stolzer said. “However, it would be a scientific fallacy to say that pumped milk is the same as milk from the human breast,” because of how breast milk changes throughout the day, not to mention that feeding by a bottle misses the intricacy of the relationship aspects of breastfeeding.”

Human milk is a dose-responsive, specific variable, meaning the response is specific to the dose: the more that a baby is breastfed and the longer a baby is breastfed, the more benefits that breast milk affords to the child and the mother. Research that began in the 1920s clearly shows that breastfeeding reduces the risk of myriad physical and mental health conditions for both baby and mother, through protective antibodies and enzymes, and through the oxytocin and prolactin “love” hormones secreted with each breastfeeding interaction.

“Choosing not to breastfeed brings a halt to oxytocin and prolactin. This brings on the grief response in mammals,” Stolzer said. “That’s why we have [high] postpartum depression rates in this country. Because the body believes that we’re grieving.”

In addition, it’s important to note the differences between cows and humans on an animal level. While both are mammals, humans and cows are not nearly the same. There are two types of mammals on the earth, in terms of how they care for their young:

Caching—i.e., cows. These mammals give birth to young who are, soon after birth, able to walk, regulate their own temperature and be left alone for periods of time while the mother forages for food. Feedings are meant to be spaced to allow this, and therefore, the milk produced is high-protein and high-fat.

Carrying—i.e., humans. These mammals give birth to young who are unable to walk, regulate their own temperature or stay quiet for long periods of time alone, and therefore must be kept in close physical proximity to the mother. Feedings are meant to be continuous and on demand, and the milk produced is low-protein and low-fat.

Quite simply, cow or soy milk formula cannot be as good as human milk for human babies: “It makes sense: We have such a different brain than a cow, and a soybean doesn’t even have a brain,” Stolzer laughed.

All kidding aside, human mothers treat their babies like those of caching mammals. This is evident not only in formula sales—a $1 trillion industry—but also in the boom in sales of helmets meant to reshape the heads of babies whose heads are flattened on one side because the baby spends more time lying down than being held.

Another important argument against formula feeding is the increasing rate of food allergies in Western cultures, Stolzer said: “The number-one allergen in human populations is dairy products. The number-one ingredient in formula is dairy. Of course we’re doing this.”

Extended Breastfeeding is Best

According to World Health Organization recommendations, babies must be breastfed for at least two years to obtain optimal benefits. Developmentally, human children are designed to breastfeed well over two years of age. For example, permanent molar eruption doesn’t occur until the child is 5 to 7 years old. In another example, Stolzer shares: A child’s sucking needs last for three to seven years—evidenced by prolonged thumb-sucking, pacifier use and hair-sucking in older children.

The average breastfeeding weaning age worldwide is three to four years. In the United States, weaning typically happens at only six weeks, the time when women return to work outside the home. The breastfeeding research available clearly shows that if all women in the United States breastfed exclusively for just six months, the nation would save $3.6 billion a year, mostly in health care costs and time spent paying parents for sick time to stay home to care for their children. If they breastfed exclusively for one year, the savings would climb to $7 billion a year.

“Five thousand to 6,000 years ago, mothers were breastfeeding their children until about 7 years old. They were ensuring the survival of the human species,” Stolzer said. “Not only is the human brain not done growing until the child is 5 to 7 years old, but the human immune system is not fully developed for five to seven years.”

Breast milk naturally has more antibodies available for the older child, because babies are designed to always be with their mothers. That’s why breastfed babies in child care centers still get sick: The antibodies in their mother’s breast milk are designed to ward off family germs, not germs from the whole community. The antibody load naturally increases as the child becomes more mobile, Stolzer explains.

It’s time that Western cultures quit playing it safe when it comes to educating women about breastfeeding, Stolzer says. The benefits of breastfeeding are consistently dependent not only on the frequency and intensity of each nursing session but also on the duration.

Worth the Work

One of the concerns of Attachment Parenting is the physical work involved in the early years, especially the first few months, when the baby’s natural sleeping and feeding schedule is so contrary to the parents’ pre-baby schedules and to what the parents want to return to because of what Western culture promotes as “normal.” But Stolzer encourages parents to stick with it.

“I know it feels really intense right now—and it is really intense right now—but in the time between birth and death, this really intense time is very small,” she said. “Attachment Parenting does not ensure that babies won’t cry or make choices that will hurt you or make you so mad you could flip,” she added. “But if you lay that foundation with Attachment Parenting, that path [of loving interaction] will always be there for them to find again.”

You can read more in the double “Voices of Breastfeeding” issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members–and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.

Public breastfeeding can infuriate us, scare us, make us feel ashamed or empower us. For one Chicago mom, it empowered her to take action and create an organization that would focus on advocating for breastfeeding at a larger level in her city (located in Illinois, USA). She wanted not only to help raise awareness of the benefits of breastfeeding but to ensure that mothers feel comfortable feeding wherever and whenever their babies are hungry.

Breastfeed, Chicago! is making changes for Chicago, one mom at a time, through a very talented board of directors that help to put together the group’s advocacy campaigns. I sat down with Katrina Pavlik, the founder of Breastfeed, Chicago!, to find out more about the organization and advice she has for others who want to advocate for breastfeeding in public. We met on a brisk day on the southwest side of Chicago and sat down over some hot coffee to chat about breastfeeding.

PATRICIA: Tell us how Breastfeed, Chicago! came to be.

KATRINA: In 2011, I created a closed Facebook group to invite people to start a conversation about breastfeeding in Chicago. Within six hours, it had grown to 400 people. (As of this writing, the group boasts a membership of 2,287 members, and more people are added daily.)

I saw a need for a community that could discuss how to make Chicago more breastfeeding friendly. From the Facebook group, we expanded and added the Breastfeed, Chicago! blog and resource list.

I wanted to see moms having more of a voice in writing policies.

PATRICIA: Chicago and the surrounding suburbs boast a high number of La Leche League (LLL) and Breastfeeding USA groups. What is different about Breastfeed, Chicago!?

KATRINA: LLL and Breastfeeding USA are so important. They provide breastfeeding support, which is critical for new moms just getting started.

Our organization is about advocacy and policy. We are working to change the view of breastfeeding. We are working on raising awareness, educating the public and advocating for policy changes.

PATRICIA: Tell us about the advocacy efforts Breastfeed, Chicago! is working on.

KATRINA: One of the big projects we are working on is a letter-writing campaign. One of our board members drafted a letter that we send out to businesses. It basically goes over Illinois breastfeeding laws and gives some information about working with breastfeeding moms. We ask that the information be posted in the employees’ space, such as a break room, so all of the employees from the top down are receiving this information. The letter is also available on the Breastfeed, Chicago! resource list so that parents can print it out and send it to any business that they feel would benefit from this information.

We also are working on a sticker campaign. We have printed up Breastfeed, Chicago! window decals that businesses can place on their doors or windows that indicate that this is a breastfeeding-friendly business.

We really want this to be mom-driven, so we have these travelling baby cafes in the summer. We meet in different areas around the city, and moms can get together, have a cup of coffee and chat. It’s an opportunity for us to brainstorm ideas that will help make Chicago more breastfeeding friendly. We take the stickers with us and moms can take a stack and hand them out at their favorite businesses, restaurants, et cetera.

The blog also has an advocacy tool kit that can be downloaded. It includes information on your rights as a breastfeeding mom in public and at work. It has tips for advocating for yourself and your child, questions to ask your pediatrician, tips to make breastfeeding in public more comfortable. It also includes a letter that you can send to your birthing hospital to express your gratitude or disappointment with their approach to breastfeeding. And it includes the window sticker and a letter that accompanies the window stickers, explaining the sticker campaign.

PATRICIA: I noticed you didn’t mention nurse-ins.

KATRINA: Breastfeed, Chicago! has never implemented a nurse-in. We want to circumvent the nurse-in. We want to normalize breastfeeding and implement interventions that will make this normal. Nurse-ins are a tertiary intervention. We are looking at what can we do before that.

When thinking about a nurse-in, there are a few factors we want to think about. One thing I always try to think about is the mom-to-be, the woman who hasn’t had her first baby yet. What message does a nurse-in send to her? [That] this is so abnormal people have to stage protests in order to do it. We want her to get the message: “This is what all my friends are doing. I see it. It’s normal.”

Nurse-ins also serve to embarrass the individuals involved. Similar to the way we raise our children, we don’t want to punish and embarrass people into change. We want to teach them and educate them into changing their behavior.

PATRICIA: What advice would you have for parents in other cities who would like to take on a venture like Breastfeed, Chicago!?

KATRINA: Use social media. Moms are online all day everyday. Moms will come together and build community. Once that community it built, moms will start to share their needs. Make sure you are listening, and when a mom brings up a need, step back and contemplate and ask yourself, how do we make this better for all moms?

Make sure you reach out to your local breastfeeding professionals. Make them feel important, and ask them to be a part of what you are doing.

And be aware that things move slowly.

You can read more in the double “Voices of Breastfeeding” issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members–and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.

Principle 8: Strive for Balance in Your Personal and Family Life – Peace Within Creates Peace at Home

Chapter 10: Nurturing Children for a Compassionate World

Wrapping it all up

We will also begin our discussion of Parenting from the Inside Out by Daniel J. Siegel, MD, and Mary Hartzell, MEd once Attached at the Heart is finished. Starting on August 17, we’ll be discussing the Introduction and Chapters 1 and 2.

We have a new and exciting launch to API Reads that will begin in September! We will be launching the option of reading a book focused on the younger child set (birth to preschool) and one focused on the older child set (school-age and above) to be read simultaneously. This will allow you to focus on the book that seems of the most interest to you at the time. We are truly excited about this new offering and hope you will be too. Come check out GoodReadsto see what books are in the queue so far!

Our discussions happen on GoodReads, so don’t hesitate to join in the conversation. We read a chapter a week. Sometimes you can’t get through the chapter but you’ll find you’ll still be able to participate in the conversation. So come join the other 400+ members who are already part of the conversation!

The recent controversies generated by depictions of Attachment Parenting in the Western media and elsewhere have revealed a fairly astounding degree of misinformation about infant and child development. Most especially, the media’s fetishist focus on “extreme breastfeeding” has revealed the tremendously wide chasm that exists between official medical recommendations about breastfeeding and the actual reality and perception of the practice on the ground.

Discussions generated by overly sexualized and highly sensationalized depictions of breastfeeding have often helped only to bolster a set of beliefs about the practice that are as dangerous as they are inaccurate. Though breastfeeding is touted by almost every recognized medical body as being one of the best things a mother can do to ensure the health and well-being of her child, the fact remains that very few infants are exclusively breastfed during their first six months of life and even fewer still are breastfed beyond their first year as official medical guidelines recommend.

Breastfeeding older babies, sometimes referred to by advocates as full-term breastfeeding, means different things to different people. Though some feel that nursing an infant past one year should be considered full term, others define it as breastfeeding a child past the age of two. Perhaps more important than any specific age reference is instead a commitment to continue breastfeeding until a child initiates the weaning process.

While beliefs and approaches to breastfeeding have certainly varied widely through time and place, the current level of societal discomfort breastfeeding engenders is without doubt an anomaly. What has since our earliest days been central to our very survival as a species has, more recently, been made to seem—by some of the more vocal critics at least—as an unnatural, immoral and even perverse practice when engaged in beyond the first year of an infant’s life. Thus, mothers who breastfeed their toddlers and very young children have been called everything from odd and eccentric to sexually perverse and even abusive.

What may therefore come as a shock to many in the West today is that from an historic and cross-cultural perspective, breastfeeding older babies and very young children is the norm. As Cornell University (USA) anthropologist Meredith Small, PhD, surmises in her groundbreaking work Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent, the “hominid blueprint of the way babies were fed for 99% of human history indicates breast milk as the primary or sole food until two years of age or so, and nursing commonly continuing for several more years.”

Breastfeeding children until the age of three or four years has been the norm throughout much of human history and remains so in various parts of the world today. Even as late as 1800, an infant born in the United States could expect to be nursed for somewhere between two to four years.

What happened over the last 200 years to have so dramatically altered breastfeeding patterns is too complicated a history to review here. It is needless to say, however, that despite no shortage of scientific and medical evidence to support much longer-term breastfeeding, this has not been enough to sway popular practice or belief in any large measure. In the United States, Canada and elsewhere, breastfeeding beyond a year—or two for the more progressive types—raises eyebrows and even ire amongst some otherwise seemingly rational people. As discussed further below, though breastfeeding rates are on the rise, the increases are small, and breastfeeding older babies is still a far cry from the cultural norm in the West.

The Science

Not only does the historical and anthropological evidence suggest that weaning before age two is unusual, but from a purely biological perspective, nursing a child through the toddler years is not in the least bit abnormal. In fact, the typical age for child-led weaning from a physiological standpoint has been estimated to fall within the broad range of two and a half to seven years of age.

As Katherine A. Dettwyler, PhD, an anthropology professor at the University of Delaware (USA), has demonstrated, this large spectrum is based upon an analysis of various biological and physiological factors derived from comparisons to other mammals of similar size. When looking at the relationship between gestation times and weaning for instance, human babies are geared to wean somewhere around four and a half years of age. Other relevant mammalian comparisons also support a much longer breastfeeding duration, including:

the eruption of the first permanent molars—5.5 to 6 years

adult body weight—4 to 7 years

adult body size—2.8 to 3.7 years.

Even the most conservative estimate, derived from an analysis of human birth weights, would suggest natural weaning occurs between 25 and 32 months of age.

The health benefits of breastfeeding are, of course, much more widely acknowledged. Not only do breastfed babies suffer fewer childhood illnesses and recover faster when ill, but the benefits continue to accrue throughout their adult lives. In every scientific study comparing breastfed babies and formula-fed babies, the breastfed babies have been shown to have a lower risk of disease and to score higher on cognitive functioning.

Breastfed babies have a much lower risk of dying from Sudden Infant Death Syndrome (SIDS) than do their non-breastfed counterparts; the formula-fed infants being, in fact, twice as likely to die from SIDS. According to “The Surgeon General’s Call to Action to Support Breastfeeding 2011,” formula-fed infants are also at a higher risk of common childhood infections, including gastrointestinal problems and ear infections, with the risk of the latter being a whopping 100% higher than in their breastfed counterparts.

The same report goes on to say that babies who are exclusively breastfed during the first four months of life have a 250% lower risk of being hospitalized for lower respiratory tract disease and a lower risk of respiratory infections. Breastfed babies also have a lower risk of developing leukemia. Formula feeding, as opposed to breastfeeding, is furthermore associated with an increased risk of some of the most serious chronic diseases of our time, including type 2 diabetes, childhood obesity and asthma.

While the early months are by far the most important with regard to the benefits of breastfeeding, research has shown that the health benefits of breast milk are cumulative. Thus, babies breastfed for 18 to 24 months do better than those breastfed for only the first six months, though as mentioned, the early months are certainly the most crucial.

While as of yet no large scale studies have been published on the specific health benefits of breastfeeding past two years of age, as Dettwyler and others have convincingly argued, there is little reason to believe the rewards cease immediately upon a child’s second birthday. Research has conclusively shown that the specific qualities of breast milk change over time in order to meet the nutritional needs of children as they grow. As such, there is evidence to suggest that breastfeeding beyond two years continues to offer important health benefits. As one of the foremost experts on the subject, Jack Newman, MD, at the International Breastfeeding Centre in Toronto, Ontario, Canada, argues, “Breastmilk still contains immunologic factors that help protect the child even if he is two or older.”

Mothers benefit enormously from the breastfeeding relationship too. For instance, it has been shown that the longer a woman spends breastfeeding, the lower her risk of ever developing breast cancer. Likewise, women who have never breastfed have a 27% higher risk of developing ovarian cancer compared to women who have breastfed for some period of time. Studies have also shown that breastfeeding for longer can maximize these protective effects. Overall, the report by the U.S. Surgeon General cited above concludes that “exclusive breastfeeding and longer durations of breastfeeding are associated with better maternal health outcomes.”

Breastfeeding Rates

The “Breastfeeding Report Card—United States, 2012,” published by the U.S. Centers for Disease Control and Prevention (CDC), found that while national breastfeeding rates are on the rise, there is still a very long way to go in terms of meeting guidelines set out by almost every recognized medical body or health association across the globe.

While current recommendations as set by the World Health Organization (WHO) and echoed by many other organizations suggest that breastfeeding be continued for two years or longer if mutually desired by mother and child, the majority of infants in the United States are weaned by six months of age. Thus, although 76.9% of women in the United States initiate breastfeeding at birth, just under half of these women are nursing at six months and only a quarter of them are still breastfeeding at one-year postpartum.

WHO guidelines likewise stress the importance of exclusive breastfeeding for the first six months of an infant’s life. Exclusive breastfeeding means giving the baby nothing but breast milk during this time. Again, despite the slew of data on the vital importance of following these recommendations, according to the U.S. National Immunization Survey (latest data for 2008), only 14.6% of babies are exclusively breastfed at six months.

As surmised by the Surgeon General’s 2011 Call to Action, although “many mothers in the United States want to breastfeed, and most try … within only three months after giving birth, more than two-thirds of breastfeeding mothers have already begun using formula.” This statistic is hardly surprising when one considers that in a study co-funded by the CDC and the U.S. Food and Drug Administration, it was found that almost half of breastfed newborns were being supplemented with formula while still in the hospital.

From a purely economic vantage point, these findings are extremely important. In fact, a study published in the April 2010 issue of the journal Pediatrics examined the costs (adjusted to 2007 dollars) associated with various illnesses including SIDS, hospitalization for lower respiratory tract infection in infancy, atopic dermatitis, childhood leukemia, childhood obesity, childhood asthma and type 1 diabetes, and found that if “90% of U.S. families followed guidelines to breastfeed exclusively for six months,” the direct and indirect savings of medical expenses would equal some $13 billion annually.

Challenges and Barriers

As evidenced above, it is quite clear that the widely available wealth of information concerning the array of physical, physiological, social, emotional, cognitive and even fiscal benefits breastfeeding provides has not been enough to alter public practice on a large scale. Thus, though the medical evidence is unambiguous and educational campaigns to shore up support for breastfeeding are now common, very few families seem to be able to actually put these recommendations into practice.

Why might this be? As revealed by a 2005 U.S. National Survey conducted by the nonprofit Families at Work Institute, more than 60% of mothers of infants and young children work outside the home. U.S. law requires only 12 weeks unpaid maternity leave be afforded to new mothers and this only for companies with 50 employees or more. A report by the National Partnership for Women and Families found that almost two-thirds of women are left without access to employer-provided short-term disability benefits, while nine out of 10 members of the workforce are unable to draw upon employer-provided paid leave to care for a new infant.

Another study published in the February 2012 issue of the journal American Sociological Review revealed that those women who breastfeed their infants beyond six months see a steeper decline in their earnings than those working women who use formula or wean their babies earlier. As Phyllis Rippeyoung, one of the study’s researchers suggested, the results of the study demonstrate that “at least as work is organized right now in the U.S., there does seem to be an incompatibility between breastfeeding for a long duration and working for many women.”

This is, of course, not to say that women who work outside the home do not, or cannot, practice longer-term breastfeeding. However, as only about a third of even the largest companies in the United States provide women with a secure area to express breast milk, doing so can often require an extremely high level of ingenuity and commitment.

Studies like those above highlight a reality too often ignored in breastfeeding campaigns: breastfeeding is both time and labor intensive. Without adequate economic, political, practical and community support for breastfeeding—spanning from the institution of much better maternity leave policies to more family-friendly workplace arrangements—many mothers will continue to face a variety of obstacles that make conforming to ideal breastfeeding practices extremely challenging at best.

Though these barriers certainly require redress if exclusive and full-term breastfeeding is to become more common, providing better maternity leave by itself may not necessarily translate into major improvements. If one looks at the Canadian situation in which maternity leave policies are a good deal better, the numbers are almost as dismal. At three months postpartum, less than half of Canadian mothers are exclusively breastfeeding, and by six months, only 14% are offering nothing but breast milk. At 12 months, about a quarter of Canadian infants are receiving some breast milk, a number only marginally better than the U.S. figures.

It seems, therefore, that something else must also be afoot. As Small and others have pointed out, underpinning these very real structural barriers to breastfeeding is a belief system that is fundamentally at odds with the biological imperatives of infant and child development. In a culture in which independence and autonomy are so highly prized that infants as young as a few months are expected to self-soothe, parents are all too frequently made to feel conflicted about responding to the cues of their infants.

This rather peculiar state of affairs has unfortunately also led to the abandonment of a host of practices that have historically been integral to exclusive and full-term breastfeeding. Regrettably, many of the practices that have traditionally helped to ensure the success of the breastfeeding relationship have become marginalized and, in some cases, even vilified in the West.

The practice of cosleeping—which had been the norm throughout most of human history and continues to be in much of the world today—though never fully eradicated, was until very recently effectively forced underground by a campaign of misinformation. Practices such as cosleeping, babywearing and comfort nursing (soothing baby with the breast instead of a breast substitute such as a pacifier or bottle), to name just a few, support breastfeeding by allowing for unrestricted access to the breast. Unrestricted access encourages a mother’s milk production and ensures a healthy feedback loop. Unrestricted access is, however, precisely that which is so often lacking today.

In sum, the abandonment of practices that support breastfeeding necessarily hampers the effect of even the most progressive policy initiatives on the ground. Simply declaring the importance and sanctity of the breastfeeding relationship, however vociferously, will have very little effect in a society that in actual fact values, and even incentivizes, mother-infant separation from an early age. Unfortunately, we live in a time in which mainstream culture sanctions by both word and deed an approach to parenting that is totally out of sync with the needs of our children. As such, the hyperbolic reactions generated by images of older babies breastfeeding and the dire state of actual breastfeeding practices are together merely twin symbols of the very widespread misunderstanding of the attachment relationship and of infant development more generally.

The fact remains that while educational initiatives and institutional changes may help to increase breastfeeding initiation among new mothers, without a fairly dramatic re-evaluation of our current beliefs, practices, values and priorities surrounding infant and child care at large, exclusive and full-term breastfeeding will continue to be a practice of only a minority.

You can read more in the double “Voices of Breastfeeding” issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members–and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.

By Rita Brhel, API’s publications coordinator, managing editor of Attached Family magazine and an API Leader (Hastings, Nebraska, USA). Originally published in the 2013 “Loving Uniquely” issue of Attached Family magazine (available free of charge to API members–and membership in API is free).

We often hear the importance of treating children fairly, but at Attachment Parenting International (API), we advocate rather to love each of our children uniquely. Because every child—just like every adult—is one of a kind, each individual parent-child relationship forms to the distinctive shape of each other’s differences in temperament, interests, opinions, aversions, conversions and other subtle nuances of what makes each person and their interactions unique.

API celebrates every person’s unique traits, but some children’s differences set them apart from societal expectations enough that daily interactions—whether at home, childcare or school—can be challenging. Rather than viewing our children through the lens of understanding, however, our society’s response is often to see these differences as “symptoms” of a disorder and to follow up with treatments that may not resolve the problem.

I am excited to share a discussion with Barbara Probst, PhD, LCSW, author of When the Labels Don’t Fit, on her approach to facilitate understanding among parents and teachers in order to discover a new relationship with sometimes-challenging children based on appreciation and respect instead of illness.

RITA: What inspired your alternative approach to “treating” children whose differences often lead them to being diagnosed with disorder?

DR. PROBST: I feel quite strongly about the way our culture seems to be viewing every difference, difficulty, struggle and quirk—every extreme or unusual behavior—as a disorder, especially when it comes to kids!

The idea for When the Labels Don’t Fit really grew out of my experience as a clinical social worker. So many parents were coming to me with kids who were intense, complex, confusing, rigid, provocative, volatile, inconsistent—challenging children who had either been given multiple diagnoses and treatments, none of which really helped, or whom no diagnosis seemed to fit.

These parents were understandably looking for some kind of explanation, some way to make sense of their child’s behavior. Yet the only thing they were offered was a negative framework, a way to categorize their child by what was supposedly wrong or missing.

There was no framework that also took into account a child’s strengths, talents, affinities, needs, style, temperament—the things a child loves and gravitates toward—as tools for understanding how that child responds to the world and who he or she really is. There seemed to be an assumption that “naming the disorder” was the key to assessing what was going on and making it better—as in the medical way, “fixing the problem” by diagnosis and cure—but it was obvious that this narrow approach wasn’t really helping anyone, neither kids nor their parents.

I got curious and started to investigate the whole “diagnosis explosion”—more and more kids receiving psychiatric labels, at younger and younger ages, for fewer and milder symptoms. The statistics are pretty staggering! For instance, one in every five American children meets current criteria for a psychological disorder, with three times as many kids now being diagnosed with emotional or behavioral disorders than were diagnosed 15 years ago. It makes you wonder if there’s really something wrong with 20% of our kids or something wrong with our definition of “normal.”

As a culture, we’ve pathologized a whole range of traits and ways of interacting with the world that used to be part of the variety of human experience. Some of the difficulties come from a poor fit with the environment, some from the struggles that are just part of living and growing up, and some are from unrealistic expectations and intolerance for kids who push the envelope or make us uncomfortable.

It’s not that a child’s struggles aren’t real or that some kids aren’t truly hard to raise. Certainly, there are kids who do things that seem odd or excessive at various points in their development, and of course it’s painful for parents when they can’t seem to reach or handle a child they love. And it’s not that “anything goes” or that kids don’t need to understand limits and develop empathy. But finding a disease-based category for the child’s problems isn’t the answer either! Just because a child has difficulty managing stimulation or frustration, hates change or needs to ground herself through touch, it doesn’t necessarily mean that those difficulties are indicators of an underlying pathology.

RITA: This is what many parents refer to as “spiritedness” or “high needs.”

DR. PROBST: I knew there had to be a better, more direct way to understand and help these challenging kids and their parents. I began focusing on the specific issue or trait, rather than the label that “explained” the trait as a symptom of one or another disease, zooming in to the feature, like perfectionism or impatience, that lay behind the problematic behavior. I wanted to understand who a child is, not what disorder he or she has—to be truly solution-focused and figure out why the roof was leaking instead of how to reward the child for mopping the wet floor.

RITA: That’s a great analogy. How did this approach work in the field?

DR. PROBST: I began to apply this new approach in my work, looking for a “difficult” child’s core features as the key to what made that child tick. Again and again, this new approach brought practical and positive results where nothing had helped before—in an amazingly short time!

I began to give presentations and workshops to parents, educators and mental health professionals, showing them how to use the temperamental map I’d developed to figure out how unusual or extreme traits interact with elements of the environment, and then how to target strategies—concretely and proactively—to a child’s specific features. It was so empowering! It gave parents real hope.

They began to see their challenging child as someone intriguing instead of someone to control or fear. What a great experience!

RITA: What temperamental differences do you find create the most friction? How would you define a “challenging child”?

DR. PROBST: Let me start by saying a word about temperament. Temperament is your essential nature, your innate way of being in the world. The early view of temperament, however, like the model Chess and Thomas developed in the mid-1970s, tended to present temperament as a series of good/bad polarities: attentive or distractible, adaptable or inflexible, and so on. I find that quite biased and value-laden, to be honest, like another set of pejorative labels.

It’s really about the fit between traits and context, not about some traits being intrinsically better than others. After all, a highly tenacious child who won’t cede her turn at the kindergarten easel until she’s satisfied with her painting is seen as resistant and antisocial, but she’s seen as admirably persistent in the science lab.

More broadly, if we lived in a culture that valued curiosity and responsiveness instead of order and self-restraint, we’d think that a child who could sit still for an hour, ignoring all the interesting people and impressions around him, as having “attention surplus disorder”!

So it varies, and traits that seem to be problematic in one situation or at one age can be an asset in another, the seeds of a child’s authenticity and fulfillment.

In addition, temperamental traits exist on a continuum, like a high need for stimulation or a low tolerance for change. Although traits in the middle may make you more mellow and adaptable to a wider range of contexts, no trait is inherently “better” or “worse” than another.

Think of it descriptively, rather than judgmentally: Some kids go off on tangents, some can’t bear to leave something unfinished, some find comfort in order and repetition or, on the contrary, always want change. Some like to plunge right in while others take time to warm up and then need to disengage slowly. Within each dimension, there’s a range, with a child tending toward the high or low end when he’s stressed.

Friction is more likely to arise, then, when a trait or its manifestation is at one of the extreme ends of the continuum, especially when the environment has a narrow zone of tolerance. A fixed time schedule—“It’s 10:00, put away your journals and get ready for recess”—can cause a shrieking tantrum in a child who has to “complete his mission” or needs to stop incrementally. A classroom full of stimulating choices can make a perfectionistic child, overwhelmed by all the roads not taken no matter what she chooses, highly anxious or irritable.

RITA: What about temperamental difference between a child and an adult?

DR. PROBST: By “environment,” I also mean the people in the child’s world. If you’re a parent who thinks spontaneity is fun, for example, and you have a child for whom that’s distressing and who really needs to know ahead of time exactly what to expect in order to feel safe, or vice versa, you’re more likely to encounter misunderstanding and conflict. For example, does your child prefer to know what she’s getting for her birthday, or does she want to be surprised?

So it’s often the mismatch, rather than the trait itself, especially when a child hasn’t matured enough to develop a repertoire of coping strategies or is blamed by adults who expect him to be the one to do all the adapting, rather than being curious and open to small changes in the environment that might create “wiggle room” or a “margin of tolerance.”

It’s also important to remember that different traits can lie behind the same challenging behavior, so you need to step back and figure out why your angry child won’t go to bed. Is it because of an irregular inner rhythm or pajamas that “don’t feel right”? Does he need to disengage a bit at a time because of high intensity and focus? Does she need to finish her game because she’s a perfectionist who can’t bear to leave something incomplete? Does he need a set of tactile markers to anchor the verbal instructions?

Threats, logic, cajoling, even offers of kindness and generosity—“how about an extra story?”—may have nothing to do with the reason your child refuses to go to bed. It’s like throwing solution darts at a situation in the hope that one will somehow stick! It’s not a matter of changing the exterior result—getting the child to “behave” and go to bed—but of understanding the interior cause and the child’s interaction with elements of the environment, including space, timing, tempo and sensory factors.

So a “challenging child” is one whose unusual, extreme or erratic traits have been misunderstood and mishandled, often due to a poor contextual fit. Your child’s need for movement or silence or control still must be met proactively, but a need that’s been respected and met, even partially, tends to lead to far less “challenging behavior” than a need that’s been ignored, denied or shamed.

RITA: What steps would you suggest for a parent seeking to learn a different way to look at and act toward their child?

DR. PROBST: One of the most powerful things parents can do is to change their language. Describe your child, to yourself and to her, as organized rather than obsessive, curious about life rather than distractible. Instead of calling her picky, tell her: “You sure do know what you like!” Instead of stubborn: “You’re not a quitter!” That helps her feel she’s not fundamentally defective and helps you feel more open and positive, which results in a less tense relationship that benefits everyone.

You can also use language to put borders around troublesome behavior. “You’re the kind of person who has a tough time with disappointment (or waiting, feeling rushed or feeling there are too many rules for how to do something).” That gives a precise, bounded and concrete place to begin, rather than making a child feel globally wrong or defective.

When a trait like low adaptability, for instance, is likely to pose a problem, talk about it in advance. Name it, predict and use respectful curiosity to help your child make a plan: “It really bothers you when kids change the rules for Capture the Flag. Variations aren’t fun to you; it just feels like they’re ruining the game. So what’s your plan if that happens today? Any ideas about what you can do?”

If your child has had a successful experience of managing a similar situation in the past, remind him of his past success and let him be the expert: “Remember how well you handled things that time the pizza place turned out to be closed? What was the secret of your success?”

If he’s not yet been able to handle it well, offer a suggestion in the spirit of experimentation. Collaborate with your child as detectives or scientists on a quest for data: “Well, I know something that tends to help people who like things to stay the same. Are you game to try and let me know if it helps?”

Tell your child: “I see that you really like to make your own decisions.” Include that feature in advance, rather than punishing your child afterward for asserting her desire to be in control. Give her a way to be involved in the decision about how to clean up, for example, before it’s time to clean up.

This kind of practical, respectful approach is so much more effective than trying to maintain complicated systems of points and penalties! Remember that your child is doing the best he can under the circumstances, given his limited resources. It’s not about reward and punishment, but about the power of self-knowledge. Your goal, in the end, is to help your child be happy and successful because of who he is.

RITA: Some parents still struggle to set limits with their children. It’s as if they and their child aren’t talking the same language.

DR. PROBST: A few core principles lie behind the more than 60 practical strategies in When the Labels Don’t Fit. One principle is to proactively and concretely match the strategy to the feature. For instance, a child who has difficulty feeling time needs a way to organize externally what she can’t organize internally. Tell her: “Two more times going down the slide,” (a unit of action), rather than, “Five more minutes till we have to leave the playground.”

A child who can’t bear disappointment needs a backup plan that’s already in place right from the beginning. For example: “My Plan B is chocolate chip cookie dough ice cream if they don’t have rocky road.” Your child can figure out his backup plan before getting in the car to go out for ice cream, then write it on an index card and put it in his pocket. Unexpected let-downs are harder, but the Plan B approach will be more likely to be accepted if your child has already practiced it in other situations.

A child with a ten-minute attention span needs a planned break after eight minutes.

A child who needs to control and becomes angry at not being in control needs a safe avenue to express power with temporal and spatial boundaries. What can she control? Can you give her a Magic Coin that she can “spend” each day on something where she can be the “boss”? That helps her learn to make and live with choices. Remember: If the only power you give a strong-willed child is the power to refuse, she will surely use it.

And so on. Once you get the idea that it all stems from “the kind of kid this is,” it becomes so much easier to be effective.

Another important principle is to show your child that you “get it.” Don’t try to make your child feel better by telling him that “it’s not a big deal”—to him it is—or that he doesn’t really feel what he feels. A child who’s hurt or angry at being rejected needs you to respect his reality and his temperament. If you deny or dismiss his experience, he’ll think you’re lying or don’t care or both. It’s better to say, “I get that it really hurts.”

Then think about his temperament. Is he the kind of person who feels better when he plunges into a new activity or when he has a quiet space to be alone? Does he tend to ruminate and thus need diversion to interrupt the cycle, or does he lock his feelings away and need help bringing them to the surface?

Too often, unfortunately, we end up rewarding a child for not being himself. A child who needs to touch or move, for instance, gets praised for not touching or not moving, rather than being given a safe way to meet his temperamental need for touch or movement. Then we’re surprised when that child becomes depressed or anxious or hostile.

Begin at the level where success is possible and build from there. Lowering the necessary dose gradually can be an empowering way to help a child manage her need for movement, praise, control and so on.

RITA: How do parents know when they may need more help, when a child should be evaluated for ADHD, bipolar disorder, obsessive-compulsive disorder, et cetera?

DR. PROBST: Certainly there are children whose difficulties go beyond an unusual temperament or poor temperament-environment fit. It would be just as wrong to dismiss a serious condition as it would be to over-diagnose a minor one. When we call every moody adolescent “bipolar” or every fidgety preschooler “ADHD,” we trivialize the very real suffering of those who truly do merit the label.

Deciding if a child may have an enduring problem beyond a quirky temperament is a complex process. It’s important to remember, however, that there’s no objective test for any of these diagnoses like there are for medical conditions like asthma or diabetes; the determination is always a subjective one. The criteria rely heavily on words like “frequently” and “often” and on checklists completed by adults rather than on a child’s self-report.

But if difficulties persist despite strategies to reduce stress and maximize adaptation, are present under a wide range of circumstances and cause significant impairment, then it may be wise to seek an outside evaluation.

It’s also important to remember that a child may still need help, even if she doesn’t necessarily meet the criteria for an official mental health diagnosis. The way our insurance reimbursement system is set up requires some diagnosis in order to justify the need for treatment under the principle of “medical necessity.” So the mental health clinician may select the label that seems the closest match, the least stigmatizing or the most likely to get the child the services he needs.

Yet in working with the child, what’s often more significant than the formal label are the specific impairing traits, which may or may not correspond to items on the official symptom list. For instance, “doesn’t feel time” and “is a perfectionist” aren’t on the list for any of the educational or mental health categories, even though they’re common problems.

RITA: Thank you so much, Dr. Probst, for your time and insights! Can you share any final thoughts on this topic?

DR. PROBST: It’s vitally important for us to keep questioning the idea that “difficult” or “different” means disordered! We need to reject the idea that every child who’s hard to handle or doesn’t fit in has a psychiatric disorder.

Many children go through tough times or seem extreme, eccentric, provocative or immature at various points in their development. But that doesn’t mean they have a disease that needs to be cured, medicated or taken as the most important aspect of who they are.

We need to ask the right questions. Instead of trying to figure out if a child has ADHD, Asperger syndrome or bipolar disorder, we need to take the labels apart, zoom in to understand each feature and find specific places where change is possible.

We need to identify the source of a problem—usually in unmet needs, discord and imbalance, not from something inherently wrong or missing in the child’s makeup—before trying to solve it by generic approaches. We need to tailor every strategy to fit a child’s specific traits and needs, and to take responsibility for how we, too, need to adapt. We can’t ask our kids to do all the work.

You can read more in the“Loving Uniquely” issue of Attached Family magazine, in which we delve into temperament and how it intersects with parenting and the development of attachment style, and we challenge the notion that every hard-to-handle child needs a diagnosis. The magazine is free to API members–and membership in API is free! Click the link above to access your free issue or join API.

When my children were young, it was common for me to take them when I traveled for speaking engagements. At their stages of development, they still wanted and needed to stay close to me.

I recall a psychologist friend of mine doubting my decision to take my then two-year-old with me. “If he cries it will help him to recover from past experiences of separation,” she said. She felt that the best way to get over separation anxiety is to encourage separations.

However, my child had no past experiences of separation to overcome, and I wanted to keep him free of such experience as long as he needed my uninterrupted closeness.

By nature there is no such a thing as “separation anxiety.” Instead, there is a healthy need of a child to be with her mother. Only a deprivation of a need creates anxiety. If we honor the need for uninterrupted physical closeness as long the child needs it, no anxiety develops. The concept “separation anxiety” is the invention of a society that denies a baby’s and child’s need for uninterrupted connection. In this vein, we can deprive a child of food and describe her reaction as “hunger anxiety,” or we can let her be cold and call her cries “temperature anxiety.”

My son, Lennon Aldort, says it well: “Our modern society and the nuclear family are large-scale experiments in extreme deprivation of the needs of both children and parents.” Parents are doing their best to move away from denying children their needs. Yet sometimes even the most securely attached parents, under pressure from extended family and friends, expect a child to live up to external expectations.

Some parents feel pressure to compare their children to others: “How come the other child is willing to be without his mother?” I always reassure parents by pointing out that the other child is a different person, and it is possible that the other child has, unfortunately, given up on what is best for himself. If your child is insisting on what is best for her, it is a reason to rejoice and to know that your parenting approach is empowering her self-confidence.

Stages of development

The confusion starts when we see a child as seemingly regressing. She was happy to stay without you at age two, and is suddenly back to needing you all the time at age three. But should we call this a “separation anxiety?” Or is it our own “intolerance for changing back and forth anxiety?”

Children try new things for a while only to recapture their old “baby” ways with gusto a year later. These changes are part of their steps forward. There is no rule that says that once a child achieves something, she must stick to it. In fact, observation tells us that most children go through such changes. They sometimes return to a former familiar stage to establish more confidence and gain a new momentum. Normal development in the early years may be two steps forward and one step back, a balance between exploring autonomy and feeling the need for security. They must feel secure and know that the door behind them never shuts, or they will not dare to try new territory.

Another reason children try things and then retreat is precisely because they become more aware. The world appears quite simple and safe to a toddler: Mommy, Daddy, couch, kitchen, doggy, yard, street, et cetera. As the child’s awareness grows, everything becomes larger and scarier. There is so much more unknown and so much that can happen. The child must be sure that springing out of the familiar doesn’t burn the bridge behind her. Being sure of that, she can try more new experiences with confidence.

Loving solutions

Sonya asked for my advice about her five-year-old child’s “separation anxiety.” “Haya wants to be with me at all times,” she said. “She even joins me in the bathroom.” Such a need can be natural even in a child who was never pushed too soon to be away from mom. But in Haya’s case, there was an early attempt to leave her at a nice, small preschool for half days. She seemed to enjoy the school but was having a hard time departing from her mother in the morning. “She was fearful and clingy, and over time she started to be more whiny at home and less happy,” her mother said.

I suggested stopping taking Haya to preschool. The result was immediate and dramatic:

“I got my child back,” Sonya said. “She is happy again and self-engaged, but she is still unable to be away from me.” Haya will regain her trust and confidence. She needs time in which there is no reminder of her experience of separation. She must know that it is up to her to be without mom. When we respond to the child, rather than try to manipulate her development, she can stay content. Keep a benign attitude of trust and peace with no hints of future expectations. On the other side, stay away from drama about her need for you. With no agenda, the child will act from within.

What if parents work away from home?

In many families, one or both parents work outside the home. Regardless of what options you may have, if you leave the baby or young child before she is ready, she is likely to develop anxiety about losing you. There are ways to alleviate the hurt and reduce the anxiety. If possible, the baby or child could stay in a familiar and loved space, such as at home or in another familiar home, with one or two intimately familiar people who love her, like Daddy, a grandparent or another consistent and loving caregiver.

Breastfeeding is nature’s magical way of telling you to stay close to your baby and toddler. When you go to work without your baby, do express milk for her but also minimize the time you are away. If after you return home your baby cries a lot, or your child is cranky and clingy, give her your full attention, validate her feelings and let the tears flow so she can heal.

Always validate and give outlet to self-expression. “You want mommy to stay with you. I know. I miss you too. I love you so much. Tell me about your day.” Make peace with your child’s anxiety about your absence, so you are not anxious yourself. Your child needs a secure parent who can listen to her.

Denial teaches denial

Some parents believe that by denying the child’s need repeatedly and consistently, the child will develop the “muscle” and learn to be comfortable away from mom. Unfortunately, the child does learn to be away from mom, but in doing so, she must detach emotionally and ignore her own inner voice. The process is not one of developing inner strength, but of resignation and of losing trust.

What we see externally is not always what the child experiences inside. As one three-year-old said to her mother: “At daycare I look smiling outside, but I am crying inside.” The innate drive of the child to please us and seek our approval causes her to comply rather than choose authentically. She learns to deny her own inner voice and follow external expectations instead because she yearns to fit in with our world. In order to do this, she must shut down her feelings and her sense of connection. Training your child to give up on herself and follow others leads to insecure teenagers and adults who, thoughtlessly, follow peer pressure, media and other external influences.

Each family must make the child care choices that they feel are best, and we must learn to love the life we have so the child will develop emotional resilience. But do allow for crying, validate the feeling and know that she may develop a separation anxiety that you will want to keep healing.

Rejoice in your child’s connection

When children rage and refuse to separate, I always celebrate. “Your child is not a tameable one,” I say. “You must have done a wonderful job of protecting her authentic being.” The more the child is rooted in herself, the less you can sway her away from who she is. We call it confidence.

When your child tells you confidently in words or actions, “I want to stay with you all the time,” and you respond to her need, she learns, “I can trust myself. My mom trusts me and takes my cues seriously.” The child who relies on herself and does not deny herself in an attempt to please you is developing self-reliance and confidence. She stays connected not only to you but to herself, creating bridges of love and inner independence.

The Girl Behind the Door by John Brooks chronicles a father’s experience from the adoption of his only child to her suicide in her teen years, including the exploration of the role of an attachment disorder.

Editor’s Note: This book contains references to parenting practices that are counter to API’s Eight Principles of Parenting but they are not provided as advice, rather as facts as the author reflects back on his personal story. The author also includes ways he could have incorporated the Eight Principles more in his parenting role, as he reflects back on his adopted daughter’s life.

API: Tell us about your book.

John: In 1991, my wife Erika and I adopted our daughter, Casey (née Joanna), from a Polish orphanage at age 14 months. She was weak and sickly from a year of institutionalization. We believe she spent much or most of her time in her crib while her dedicated and valiant caregivers essentially performed triage on the older disabled children at risk for self-harm. But within days in our care, Casey’s developmental rebound was nothing less than astonishing. Over the years, she blossomed into a beautiful, smart, popular young lady living, by most measures, a privileged life in the San Francisco Bay area. But she wasn’t perfect. She suffered violent meltdowns and tantrums, crying jags and hypersensitivity, and seemed completely impervious to discipline, all in a manner out of proportion to age or circumstance. What were we doing wrong? Therapist after therapist, who knew full well about her past, told us “just be tougher with her.”

In the fall of 2007, she accomplished her dream–she was accepted at prestigious Bennington College for the fall of 2008. She never made it. In January of that year, she took our car, drove to the Golden Gate Bridge and jumped. Her body was never recovered.

The Girl Behind The Door is my search for answers to Casey’s suicide. Why did she do it? What did everyone–especially the professionals–miss? What could we have done differently? What could we share with other adoptive families? Through research and interviews with adoption and attachment experts, I learned about the attachment issues and disorders that burden so many adopted children and result in the behaviors we saw in Casey. It explained everything about her. I share with the reader everything I learned about parenting and therapy techniques that have proven effective in helping orphaned children cope with the lasting effects of birth trauma, abandonment and emotional deprivation.

There are numerous books on adoption and attachment from a clinical perspective. Other personal adoption stories seemingly end with wheels up from Moscow or Beijing, implying that the heavy lifting is over when it has only just begun. The Girl Behind The Door integrates a tragic personal adoption story with information from the experts to teach other families what we learned too late.

API: What inspired you to write the book?

John: I think that many parents who’ve lost a child feel compelled to do something to give their life meaning. Parents join grief and advocacy groups, and lobby for new laws to protect others from tragedy, among other things. I’ve joined the fight to install a suicide barrier on the Golden Gate Bridge–the deadliest structure on Earth for suicide. But my journey led me beyond the bridge to determine what led Casey there in the first place. So I wrote a book.

API: How will this book benefit other families?

John: Much more is known today about the effects of abandonment and adoption than was known in 1991, before researchers had an opportunity to study the long-term effects of deprivation on Romanian orphans. Today attachment resources and therapists are still difficult to find, even in big cities. Many therapists are still unschooled in specialized attachment therapies and treat adopted children as they would any other children. While I don’t claim to have uncovered every attachment resource (see my Resources section), I’ve found many that readers can use as a starting point for their own journey in trying to get help for themselves and their children. I’m not a professional, and I don’t diagnose or dispense advice. But by raising awareness to the challenges that adoptive families face even today, I hope to make a difference.

API: Is there any special message you have for parents of children with attachment disorders?

John: It is important to note that not all adopted children and adults suffer the effects of their early life trauma, but many do. Here are some of my lessons learned:

1. Prospective adoptive parents need to be thoroughly schooled by a qualified professional before they get on that plane or head for the delivery room. In all likelihood, that schooling will not come from the adoption agency or facilitator. Even better, these parents should meet adopted adults and hear about their life experiences.

2. Have your child tested and diagnosed by a qualified professional [if you suspect problems]. All too often, attachment disorder or reactive attachment disorder are convenient catch-alls when other disorders may be at work and difficult for the untrained eye to differentiate, such as attention deficit disorder, attention deficit hyperactivity disorder, fetal alcohol syndrome, Asberger’s syndrome and autism. If your child isn’t properly diagnosed, he or she can’t be properly treated.

3. It is absolutely vital to find the right kind of help. A qualified adoption therapist knows what questions to ask and how to ask them.

4. Be prepared for the kind of parenting and family experiences that may not be comfortable for you but are necessary for your child’s well-being.

API: What are your views of Attachment Parenting International and what API is doing? How does your book work within our mission statement?

John: I think that API and the support and practices it promotes for families are exactly what is needed for the adoption community. Not only are its resources invaluable, but providing a sense of community is very important for parents (like us) who often feel beaten, desperate and utterly alone. That sense of belonging to others with a shared experience is a powerful coping tool.

API: Is there anything else you’d like to share?

John: I think the book makes clear that, despite our difficulties, Casey meant everything to us. She was our entire world. And despite her tragic loss and the shards of our broken family left behind, I feel like the luckiest guy in the world to have been Casey’s dad. I could never imagine a more magnificent daughter.

API: Where can people find more information about your book or your work?

My name is Melissa, and I am a mama to four kiddos. I’ve been an Attachment Parenting mama since before I knew it was a phrase. For me, having the “perfect birth” with my first baby was The Most Important Thing Ever. I really can’t stress enough how tied up I was in having a perfect birth: dim lights, soft music, soft voices, at home, with just a doula and my then-husband. I would catch the baby in my arms, and we would cry and laugh, and I would heal so quickly, and life would be perfect.

Editor’s Note: As one of the Eight Principles of Parenting, Attachment Parenting International encourages parents to prepare for pregnancy, birth and parenting, which includes informing themselves about healthy birth and birth options. API birth stories are published for the purpose of giving parents a voice in telling their birth stories, and these stories include decisions and understandings that represent various levels of understanding about optimal birth choices. The author’s description of her experiences should not be considered medical advice or representative of API Principles. Representative of the API Principles in this birth story are the pursuit of education, knowledge, and empowerment as a parent to guide the choices that suit the well-being of one’s own family.

Then reality struck. At 20 weeks pregnant, my baby was diagnosed with intrauterine growth restriction, and I was told I had a placenta previa. This meant immediate bed rest with the strong possibility of a Cesarean section later. I was crushed.

At 35 weeks, though, my spirits were renewed when the doctor found that my placenta had moved, so a vaginal birth was now a possibility. However, since my little one still wasn’t growing very well, I would remain on bed rest and would not be allowed to have a homebirth. My now ex-husband was in the Marines, and “allowed” is the exact word for how pregnancies were handled by our military hospital at that time.

No one asked about my birth preferences, but I had a printed birth plan. It is my understanding that my husband was asked about circumcision, but neither of us was asked about formula, sugar water or pacifiers. My husband was aware of my feelings about circumcision, that I preferred the baby be left intact. I explicitly stated in my birth plan that I wanted to breastfeed within an hour of giving birth and that the baby was not to receive bottles or pacifiers.

Labor came on quickly one night when I was nearly 40 weeks along. I had no pain or even real discomfort, and then suddenly, BAM, full-blown labor. I managed to call my husband, who came home from his second job, saw how very in labor I was, freaked out and called the ambulance. By the time I got to the hospital 20 minutes later, I was 7 cm dilated and fully effaced.

The hospital handled my birth in the same controlling way they handled my pregnancy:

“No! Of course you’re not allowed to get out of bed!”

“What? Why would you want to eat or drink right now? You’re in labor, get back in bed!”

“Yes, you HAVE to have an IV.”

“This is your first baby; you have no idea what you’re doing.”

That last line is what I heard when I said that I thought labor was going a lot faster than I thought it would, and I didn’t think it would be too much longer before baby got here.

Hearing those words was the final straw. I was 19. I was in horrific pain. I was tethered in bed with the IV, monitor and cables so I couldn’t get up or move. I was being talked down to. I started to cry. Then I started to yell. That’s when a nurse walked in and said, “The doctor says you can have this for the pain.” With that, she stabbed me with a needle and emptied a syringe of what I later discovered to be Demerol into my arm.

I remember I was on the phone with my mom, trying to tell her what was happening, but as I was speaking to her, the room became dark, and I suddenly couldn’t hear anything. I was blind, deaf, mute and in horrible, horrible pain. Pain was all I could feel. I passed out.

Then three things happened simultaneously: I awoke; my water broke, gushing green, smelly, meconium-filled fluid everywhere; and I screamed involuntarily.

Nurses came running, the doctor came in and everyone started yelling at me, “Stop pushing! Stop pushing!”

I gritted my teeth and yelled back, “I’m not pushing!” The baby was coming. I couldn’t stop it. I wasn’t pushing.

At that point, I reached out for my husband, who was standing off to the side in shock. I put my hand on his arm. A nurse slapped my hand away from him. She said, “He’s your husband, don’t do that to him.” My husband just stared, his jaw agape.

Then, with one tiny push (the only one I was “allowed”), out came my beautiful baby boy. And I passed out.

When I awoke four hours later, my baby had been through the hospital’s baby assembly line: immunization, circumcision, bottle of formula. (Despite my feelings, my husband made the decision to have the baby circumcised.)

I did eventually establish breastfeeding, but due to the lack of support and lactation services in the small town where we moved just after the birth, breastfeeding was very difficult. We dealt with a month of thrush, hyperactive letdown and oversupply issues. Eventually, Riley went on a nursing strike, and I ended up switching to formula.

I suffered severe postpartum depression lasting over eight months following Riley’s birth. I was in the last days of my marriage, only 19 years old and very much alone. I received no support and no help. I didn’t even know where to go for help.

I am still dealing with the emotional trauma of Riley’s birth. The hospital left me feeling powerless and small. Telling my story helps me feel like I’m doing something about it. I’ve had three more children since Riley, and each birth has been immeasurably better than Riley’s, which has definitely helped a lot.

My second birth was with Mason, a late baby born at just over 42 weeks. It required two procedures and three days to get labor started. I had a pretty aggressive doctor, and I was too overwhelmed to speak up and ask for the C-section I felt I needed. Mason nearly died at birth from complications of shoulder dystocia. He was in the NICU for a few hours, but luckily he recovered quickly and was back with me by the next morning.

I don’t compare Mason’s birth to others, because of the complications. The doctor had no way of knowing that there would be an issue of dystocia. That whole situation came down to what was necessary, and not what anyone “wanted.” I don’t feel bad about his birth or particularly good about it–I’m just thankful he survived. As far as circumcision goes, Mason’s dad and I discussed it at length, and I agreed to let him make the decision. He chose to circumcise. I am at peace with that decision because I know that someone who loves my son very much made that choice with love. While I don’t think it was the best choice, it was his dad’s choice, not the hospital’s.

My fourth birth was a scheduled early induction to avoid complications, because the doctor and I both suspected that Harry was going to be a big baby. Given the situation with Mason’s birth, we felt good about proceeding with an early induction. Labor lasted just over two hours. I asked for an epidural, but it failed, so I felt every second of those two hours. Overall, I feel good about this birth, too. And I’m happy to say that Harry is an intact [uncircumcised] baby. He just turned two and is still nursing, thanks to all of the wonderful support I received from La Leche League and the local lactation consultants.

However, I think the birth I felt best about was with my daughter, my third child. On my due date, my water broke on its own at around 10 a.m., before contractions started. I took a shower, got dressed, called the sitter, cleaned the house, and just generally took my time getting everything ready for the baby. At about 3 p.m. my husband and I headed to the hospital. I was started on some Pitocin, and things moved fairly quickly after that. I labored while moving around, walking, eating freely, drinking water and juice whenever I felt like it, with my husband holding my hand and rubbing my back. We watched movies and played cards. Labor was intense but manageable, and the nurses were happy to leave me to it. I had telemetry monitoring, so I could go wherever and do whatever I wanted.

By about 9 p.m. the pain was bad enough that I couldn’t walk or talk or move, so the nurse offered to check me. I was at a very disappointing 3 cm, so I asked for an epidural. The epidural must have made my body relax because my daughter was born less than an hour later after only two pushes.

The doctor laid her on my tummy, and they left the cord alone until it stopped pulsing. The nurses asked if they could please take her to clean her up. They had her back to me, weighed, measured, wiped down and swaddled within 10 minutes. The staff cleared the room fairly quickly, and the lactation consultant stopped by to offer support. I was given a breastfeeding kit (not formula), as well as information on renting a pump and getting an SNS (supplemental nursing system) “just in case.” After that, I was left alone with my daughter and my husband for the rest of the night.

No one questioned my authority in making the decisions regarding my care or the care of my daughter. The two interventions I had were both necessary, and I have no regrets about them. I had good friends who offered advice and assistance in the months leading up to Lana’s birth, and I had a husband who wasn’t afraid to stand up for me.

Having what I considered to be a nearly perfect birth experience gave me hope. For the first time, I stopped blaming myself for the way things went with Riley’s birth. I had always felt like somehow I was the problem in that. But I realized it was just those particular nurses and doctors.

I guess if I had to sum it up in one sentence, I’d have to say that the biggest difference was that with Riley’s birth I was treated poorly and I was the least important person in the room, but with Lana’s birth I was part of the team and the person with the most input.

Connecting with our children for a more compassionate world.

Attention API Members

Attachment Parenting International is grateful to those who contribute to its publications, including TheAttachedFamily.com. It is to be noted that API entertains a variety of perspectives and embraces opportunities to challenge and strengthen its API family. Please find what works for you, support and encourage, and leave the rest behind. For more on API’s perspective on parenting, visit the API website by clicking on the link in the Additional API Resources below.